The Neuroscience of Being 'Us' - Part 2 How threat and unresolved emotion changes the brain

Interactions between the cortex (frontal lobe) and limbic system; the anterior cingulate and insula

(Part 2 of a 2 part series see here for part 1)
There is another important part of the mid-brain (adjacent to the amygdala) that has a function in registering threat and helping to lay the foundations of trauma. It’s called the Anterior cingulate cortex (ACC) and is important as a filtering system. It is another part of the brain that is functionally degraded as a result of trauma. It possesses structures called spindle cells which wrap around the nerve bundle of fibres linking the left to the right sides of the brain. These connections between left and right may be very important for how emotions are integrated and the meaning made of the emotional events in our lives– and it may be key to why techniques such as EMDR which stimulate better integration allow re-wiring to occur .

The Anterior Cingulate Cortex ACC is primarily involved in fear conditioning as it normally inhibits the amygdala, which as we know is the primary area for threat encoding. However, it also appears to play a role in emotionality, selective attention, and certain social functions, including emotional attachments and parenting, as well as generation of the concept of the self in relation to society. It is my contention that this is the part of the brain that fails in attachment disorder, and other more chronic relational trauma disorders. I have particularly noticed that the sense of self is often highly distorted, even in very outwardly functional people. They operate despite their own self-loathing to become very respected/hard-working/ achieving people but when questioned they cannot see that anything they have done has any worth. If you press them they will acknowledge grudgingly that it might have value but they do not feel that emotionally, it is more of an intellectual awareness. The ACC might be the part of the brain that we bring ‘online’ in trauma treatment, as when we do EMDR. We rewire the responses by a process of extinguishing the conditioned response of self-hating or limiting. I will discuss this within the tools section.

The insula (another part of the cortex just behind the PFC) is an area that helps interpret incoming sensation, rating it dangerous or not. It is highly involved in our subjective experience of pain, for example, and can become active just by imagining pain as well as in more pleasant experiences like music appreciation. It monitors incoming signals from the body (particularly the physiological experience of emotions like sadness, fear, anger, etc) and combines this information with the limbic system and brainstem to generate appropriate responses. As we will see later, when the signals get scrambled by unresolved emotional memory, stress is able to overwrite any inhibitory stimulus and most incoming signals are interpreted as painful, dangerous or life-threatening, causing all sorts of chronic pain and stress-related diseases.

Left and right sides; the Corpus callosum connection

Despite the fact that the cortical structures are split into left and right hemispheres, the brain remains undivided at the level of the lower reptilian brain structures - sometimes referred to as the ‘subcortical bridge’ In treatment, the client and therapist may also be able to capitalise on this. Nonverbal information, including “unconscious or preconscious codes, nuances we can never attach a name to,” cross most readily (Austin, 1999) . Using somatic experience as an entry point in therapy and maintaining mindful awareness of the body may facilitate information processing by enhancing information transfer between the hemispheres. This is what is aimed for in clinical hypnotherapy intervention by engaging the imaginative right hemisphere. However, there is controversy in hypnotherapy as to the nature of hypnosis as we have already shown with regard to whether it is a state separate from normal everyday experience or not. This was developed further by the great hypnotherapist and psychologist Pierre Janet.

We have already intimated that in subjects with PTSD and other lesser traumatically encoded states, the amygdala may become hyperactive towards “a generalisation of the fear response” or conversely underactive which “may allow continued functioning in situations characterized by ongoing threat” such as that experienced by a child who is under threat from their caregiver. That this may be in part to do with the alteration in function of the left and right hemispheres and specifically their inter-communication is an ongoing debate with psychotherapy.

This is an extract from my book The Scar the Won't Heal - available now on amazon. In the next instalment I look at Interactions between the cortex and the limbic system.

The Neuroscience of Being 'Us';Part 1 The cortex and emotion

The region of the brain called the prefrontal cortex (PFC) is really what defines us as human; it is crucial for how we pay attention, it enables us to put things in the ‘front of our mind’ and hold them in awareness. It is the basis of our moral system and capacity for empathy. Studies of people who have suffered injury to the PFC show us that it is an important brain area for creating our ‘map of the world’ i.e. the mental representation of our outer experience. Various different parts of the cortex have specific functions:

The Pre-Frontal Cortex (PFC) regions in the two hemispheres

• The Medial Pre-frontal Cortex (MPFC) is the integration centre involved in coordinating left and right sides with direct connections to the amygdala in the limbic system. This part is involved in our sense of curiosity and awareness and is the part that we target in therapy particularly for dissociated clients who have lost connection with their bodily self. It is activated during mindfulness meditation, mindful awareness or psychotherapy.
• The Dorso-lateral Pre-frontal cortex (DPFC) is the site of our short-term or working memory and has no direct connection with the limbic system. It is the last bit to develop in the human and often the first to go with ageing. We’ve all had the experience of walking into a room and forgetting why we went there – this is a failure of this part of the brain to hold the requisite information for long enough for us to commit it to longer term memory.
• The Right Orbital Pre-frontal cortex (ROPFC) (so called because it is directly behind the right orbit of the eye) is most specifically concerned with emotions and arousal regulation as it has good connections with the limbic system and can inhibit activation (this is important in trauma therapy). It develops early in life and is the social centre of the brain, which, if given support and trusting relationships in those early years, becomes more capable of regulating emotion but it depends on good parental attachment (Shore, 2007) . It becomes our 'soothing centre' if promoted by secure attachment. Self-soothing or auto-regulation is very important for subsequent adult emotional regulation. If childhood experience failed to develop this part of the brain a pattern of dysregulated ‘up and down’ or entirely absent emotions results. Our prisons are full of such people where auto-regulation has never been learnt successfully.

Through its links with the limbic system, and the immune system (via regulating levels of cortisol in the HPA axis), the PFC acts as the interface between mind and body and so is implicated in such medically unexplained conditions such as fibromyalgia, whiplash or pelvic pain. These could be construed as the body’s way of expressing emotions through pain; this is termed somatisation. Defined as feeling emotions through the body rather than as feelings, these issues are common in people “in whom emotion is undifferentiated and unregulated” (Shore) . In other words they can’t tell one emotion from another and they may find it difficult to put words to feelings; memories may also be completely dissociated from feelings. This is common after trauma – particularly attachment trauma. The brain gets confused as to what the input represents and may conflate pain with the emotional pain of betrayal/abandonment – they share many of the same pathways.

I met one such person who was on a training course with me. He described some awful events that happened in his childhood without emotion of any kind. He was suffering from this condition, termed alexithymia, (an inability to describe emotions with words) which could be seen as a failure of the ROPFC. Somatisation is not a commonly understood concept in conventional medicine although, in fact, it lies at the base of many of the chronic pain syndromes I am exploring in this book. It is a direct example of how poor relationships and unexpressed emotions make us ill.

The cortex is known to go ‘offline’ in the aftermath of trauma which may explain the sudden switches from hyper to hypo arousal of conditions such as PTSD and other trauma related conditions. As the cortex is normally the modulator of experience, helping to bring logic and a ‘wider view’ its failure to inhibit the limbic system prevents such fine tuning of curiosity and reason. In trauma work we often talk about ‘getting curious’ as the antidote to these limbic states. We need to engage people in what happens when they think a certain thought or act a certain way, enabling them to tune in to their body states – something that they may have actively blocked from childhood onwards. When they begin to look at their reactions as symptoms (i.e. “I've been triggered and this is my survival brain in charge”) and not from an underlying pathology (i.e. I’m mad, bad or weak), they begin to see how extraordinary the human brain is and their curiosity (MFPC-mediated) is aroused . This is a direct antidote to the dissociation and emotional dampening that many people suffer after a traumatic experience. It is the direct target of intervention, whether by linking the two sides of the cortex as in EMDR or by hypnotherapy and CBT whereby we engage the imagination and the thinking brain respectively. We cover these therapies in more detail in my website. Suffice to say no-one need suffer permanently; these states can be reversed as the brain is plastic (neuroplasticity).

This is an extract from my book The Scar the Won't Heal - available now on amazon. In the next instalment I look at Interactions between the cortex and the limbic system.